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Dealing with patchy skin

Leukoderma may be congenital but, often, it is aggravated or even triggered due to negligence. here are some tips on how to deal with white patches — and precautions on how to steer clear of them

In most parts of Asia and Africa, fair skin is perceived as beautiful. But if this “fairness” is patchy or if you have a white patch on your face, it is a cause for severe emotional stress and can lead to several psychological and social problems. As I promised after my series on dark spots on the face, I have decided to dedicate the next couple of articles to white patches or leukoderma on the face that could also be just as disturbing if not more. I usually start an article with common causes of a symptom. This time around, I will start with the less common causes as they are the most alarming ones.

The most dreaded condition causing white patches on 
the face is vitiligo, often called leukoderma, though both terms are conceptually different. Vitiligo is considered an “autoimmune disorder”, when the body’s immune system turns against the body itself, attacking the cells that give colour to the skin as if it were an enemy. While there is evidence that vitiligo can run in families, it is not yet clear how much risk for developing vitiligo is carried by genes. Since it is not caused by a virus or bacteria, it is definitely not contagious. It is important to understand this and give the much needed emotional support to the sufferers as vitiligo can be both triggered and worsened by stress.

Injuries in the form of cuts, abrasions and even sunburn can also induce vitiligo. Hence it is important for those with this condition to avoid tight fitting footwear or clothes and any jewellery that cause constant friction on any part of the skin. Practitioners of certain alternative forms of medicine restrict the intake of citrus fruits rich in Vitamin C in vitiligo patients. Though this may seem logical since Vitamin C is an ingredient of many fairness products, it has just the opposite effect on vitiligo because of its anti-oxidant properties.

The treatment of vitiligo traditionally has been disappointing. But developments in melanocyte culture and transplant techniques have introduced some new hope. So if you are a vitiligo patient who has lost hope because of the ineffective treatments, it is time to see your doctor again to find out what is new.

Leukoderma is a more generic term for white skin. When the white skin is because of a chemical, then it is called chemical leukoderma. Chemical leukoderma is an industrial disorder in most parts of the world and the common causative chemicals are phenols and catechols. But in the Indian subcontinent certain unique ‘consumer product’ related patterns can be observed.

A bindi is a decorative mark worn in the middle of the forehead by Indian women. The glue in the sticker type of bindis often contains high concentrations of a chemical that can cause leukoderma. This depigmentation occurs in women at an extremely prominent site (center of the forehead). Unfortunately, the pressure to conform to social norms makes many women continue to use it even when the damage caused by it is clearly visible. Common items like rubber slippers, synthetic leather wallets, watch straps, hearing aids and rubber gloves can also have certain chemicals capable of causing leukoderma. Risk is high when the offending item is in tight apposition against the skin, and is kept there for prolonged periods leading to leaching of the offending chemical.

There are some white birthmarks that appear at birth or shortly thereafter. Though birthmarks are stable, they can grow in proportion to the growth of the body. Only surgical treatment is available and it is better to leave the birthmark alone unless the cosmetic disfigurement is severe.

However, if you notice an anaesthetic white patch on your face or body, you should consult a doctor, so it it can be diagnosed immediately.

Many of the mothers reading this article may have noticed dull white patches on the face of their little ones and I am sure most of them would be worried by now. Before you take them to the pediatrician to rule out vitiligo, please read Part II of this article after a fortnight, in which I will discuss common causes of white patches on the face.

(Dr Bell R Eapen is a Dubai-based specialist dermatologist 
with Kaya Skin Clinic. Write to him at wknd@khaleejtimes.com)